| NPI | 1619162518 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 111885) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 1497663091) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2015-03-19 |